BMC Neurology最新文献

Background: This study utilized the MIMIC-IV 3.0 database to investigate the correlation between the endothelial activation and stress index (EASIX) and the short-term (30-day) and long-term (1-year) death rates of patients with ischemic stroke (IS), thus providing insights into optimizing the risk stratification and management in clinical practice.

Methods: Data from the MIMIC-IV 3.0 database were used. IS patients were identified by ICD codes. log2-EASIX scores were calculated based on admission platelet count, creatinine, and lactate dehydrogenase levels and patients were grouped into quartiles. The primary outcome was 30-day all - cause death rate, and the secondary was 1-year death rate. Multivariate Cox models, LASSO regression, Kaplan - Meier curves, restricted cubic splines, subgroup and interaction analyses were performed. R software was used for data cleaning and statistical analysis.

Results: This study enrolled 3,625 acute IS patients, stratified into four groups by log₂-EASIX quartiles (Q1: -3.24 to -0.55; Q2: -0.55, 0.17]; Q3: 0.17, 1.06]; Q4: 1.06 to 7.15). Q4 had markedly higher 30-day (32.0%) and 1-year (50.7%) mortality than Q1 (15.0%, 29.3%). Fully adjusted Cox models showed Q4 vs. Q1 had elevated 30-day (HR = 1.291, 95%CI:1.035-1.610, P = 0.024) and 1-year (HR = 1.246, 95%CI:1.059-1.467, P = 0.008) mortality risks, with a significant 1-year mortality trend (P = 0.004). RCS analysis revealed nonlinear associations between EASIX and both mortalities (all P < 0.05). Bonferroni-corrected subgroup analyses found only GCS had a modifying effect (P < 0.004). ROC analysis showed EASIX had moderate predictive value (30-day AUC = 0.7545; 1-year AUC = 0.7277).

Conclusions: EASIX is independently linked to short- and medium-term ACM in ICU-admitted IS patients; higher EASIX correlates with increased mortality, serving as a useful risk stratification and prognosis tool. Limited to moderate-severe ICU IS cases, prospective studies are required to verify its causal mechanisms.

Background: Vestibular migraine causes recurrent vertigo attacks that significantly impact quality of life. While various preventive medications are used, their comparative effectiveness was unknown. Previous systematic reviews have been limited by pairwise comparisons only or exclusion of newer treatments. The lack of head-to-head trials comparing all available treatments further complicates evidence-based decision-making. This evidence gap has real-world consequences, has also substantial economic burden of Vestibular migraine. There is a need for direct comparison studies between the most promising treatments to provide clearer guidance for clinical practice.

Objective: To determine the comparative effectiveness and safety of preventive treatments for vestibular migraine through systematic review and network meta-analysis. Given the lack of head-to-head randomized trials, a network meta-analysis (NMA) provides the most appropriate method to compare available treatments by combining both direct and indirect evidence.

Methods: We searched Embase, Scopus, PubMed, and Cochrane Library from inception to January 15, 2025. We included randomized controlled trials (RCTs) and prospective observational studies (n ≥ 30 for CGRP antagonists) comparing preventive treatments for vestibular migraine diagnosed according to either Bárány Society/International Headache Society criteria (post-2012) or Neuhauser criteria (pre-2012). Primary outcomes were monthly vertigo frequency and quality of life (DHI scores). We conducted frequentist network meta-analysis and assessed certainty using GRADE.

Results: From 340 identified records, nine studies met inclusion criteria. Five RCTs (419 patients) comparing seven treatments were included in the network meta-analysis. All treatments significantly reduced monthly vertigo attacks versus control. Propranolol ranked highest (P-score: 0.794; -7.04 attacks/month, 95% CI -12.77 to -1.31), followed by valproic acid (-5.95, 95% CI -9.01 to -2.89) and venlafaxine (-5.94, 95% CI -8.98 to -2.90). Galcanezumab showed moderate efficacy (-5.80, 95% CI -10.61 to -0.99) with zero discontinuations. Network heterogeneity was negligible (τ²<0.001). Evidence certainty was moderate for galcanezumab and low to very low for other treatments.

Conclusions: All evaluated treatments effectively reduce vertigo frequency in vestibular migraine. While propranolol showed the largest effect, this relied on indirect evidence. Galcanezumab offers the best balance of efficacy, tolerability, and evidence quality. Head-to-head trials are urgently needed.

Prospero registration: CRD420251089507.

Background: Virtual reality (VR) has emerged as a promising tool in neurorehabilitation to improve motor function in individuals with hemiplegia. VR applications are typically categorized into immersive and non-immersive types, both of which have demonstrated efficacy in enhancing upper limb function. This study aimed to compare the effectiveness of immersive virtual reality (IMVR) and non-immersive virtual reality (NIVR) therapies in improving upper limb motor function in individuals with subacute hemiplegia.

Methods: This single-blinded randomized controlled trial included 30 participants (aged 25-40 years, both male and female) with subacute hemiplegia. Individuals with pre-existing musculoskeletal or neurological conditions affecting the upper limb, severe motion sickness, photosensitivity, or perceptual deficits were excluded. Participants were randomly allocated into two groups: Both groups initially received conventional physiotherapy, following which the immersive VR and non-immersive VR interventions were administered to the respective group. Each session lasted 60 min, with three sessions per week for six weeks. Assessments were conducted at baseline, post-intervention (6 weeks), and follow-up (6 months) using the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and Stroke-Specific Quality of Life Scale (SS-QOL). The System Usability Scale (SUS) and User Experience Questionnaire (UEQ) were used to evaluate the safety and usability of both VR methods.

Results: No statistically significant differences were observed in baseline characteristics between the groups. SUS and UEQ scores also showed no significant differences in user experience. However, IMVR demonstrated statistically significant improvements in FMA, WMFT, and SS-QOL scores compared to NIVR at both post-test and follow-up (p < 0.05).

Conclusion: Both immersive and non-immersive VR therapies were effective in enhancing upper limb motor function and quality of life among individuals with subacute hemiplegia. However, IMVR showed greater clinical significance in improving motor function and quality of life. Future research should explore the integration of VR across different stroke stages and focus on developing simple, task-specific games to further support rehabilitation.

Trial registration: This clinical trial was registered in clinicaltrials.gov under the trial ID NCT06615141 on September 26, 2024.

Background: Parkinson's disease (PD) is a chronic neurodegenerative disorder characterized by motor and non-motor symptoms, with neuroinflammation hypothesized to contribute to its pathogenesis. Systemic inflammation, as indicated by elevated peripheral inflammatory markers, has been implicated in PD; however, the relationship between complete blood count (CBC)-derived inflammatory markers and the presence of PD remains unclear.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, including 15,349 participants. Propensity score matching was employed to balance baseline characteristics between PD and non-PD groups. Multivariate logistic regression models were used to evaluate the association between CBC-derived inflammatory markers, particularly the neutrophil-to-lymphocyte ratio (NLR), and the presence of PD.

Results: After multivariable adjustment, elevated NLR was significantly associated with higher odds of PD. Individuals in the highest NLR quartile had higher odds of PD compared to those in the lowest quartile (OR: 2.18, 95% CI: 1.04-4.68; P for trend < 0.0001). This association was consistent across subgroups, including gender, diabetes status, hypertension, obesity, smoking, and alcohol consumption. Other CBC-derived markers, such as the monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), did not show consistent associations with the presence of PD.

Conclusions: Elevated NLR is significantly associated with the presence of PD among U.S. adults, independent of key confounders. However, due to the cross-sectional study design and reliance on self-reported PD status, causality cannot be inferred, and misclassification bias cannot be excluded. Further longitudinal studies are warranted to validate these findings and clarify the temporal relationship between systemic inflammation and PD.